Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center

A Scoping Review of Culturally Adapted Mindfulness-Based Interventions for Communities of Color

Introduction: Mindfulness-based interventions (MBIs) are effective in improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD). However, research on how MBIs have been tailored for racial and ethnic minoritized communities is limited. To address this gap, this scoping review utilizes the Ecological Validity Framework to systematically explore cultural adaptations in MBIs for communities of color. Concurrently, this review examines the effectiveness of culturally adapted MBIs. Methods: Following PRISMA guidelines, the authors conducted a search on MEDLINE, PsycINFO, and Embase databases from 2010 to 2023. Inclusion criteria required studies to be published in English, accessible in full-text, and peer-reviewed, focusing primarily on communities of color or diverse non-White populations (comprising 75% or more of the sample). Exclusion criteria were studies primarily centered on behavioral interventions other than MBIs, studies lacking primary outcomes, and studies not explicitly addressing cultural adaptations. Results: Search results identified 371 publications, 13 of which met the inclusion criteria. The most frequently reported cultural adaptations were surface-level adaptations, which can enhance the relevance of MBIs by modifying the language, content, format, or intervention delivery. MBIs with surface-level adaptations reported significant improvements in mental health outcomes, including depression, anxiety, and stress levels. Conclusion: Findings from this review indicate that culturally adapted MBIs for communities of color could potentially make them more relevant and acceptable. Surface-level and deep structure adaptations are both necessary to ensure MBIs are responsive, relevant, and sustainable across diverse contexts and populations.

Using a Randomized Clinical Trial to Test the Efficacy of a Culturally Responsive Mobile Health Application in African Americans

Mindfulness is a promising health promotion strategy for African Americans, and it is imperative that culturally responsive mindfulness approaches be accessible to this population. One way to address this need is to develop and test if culturally responsive mobile health (mhealth) applications are efficacious in reducing stress-related outcomes in this population. With this goal in mind, we employed a repeated-measures randomized control trial (RCT) across a 12-week intervention period to evaluate if participants in the intervention group outperformed a wait-list control group in reductions in stress, depressive symptoms, anxiety, emotional regulation difficulties as well as in increases in self-compassion, resilience, and mindfulness attitudes and behaviors. Our sample included 170 Black/African American participants who were randomly assigned to either the intervention condition (n = 84) or the wait-list control group (n = 86). Participants in the intervention condition reported more self-compassion, used more mindfulness, and had greater self-efficacy using mindfulness; yet, no other differences were evident. Participants expressed high levels of satisfaction with the app and gave it a positive rating for its relevance to their lives. These findings support the efficacy of a culturally responsive mindfulness mHealth app to enhance self-compassion and increase the use of health-promoting behaviors, like mindfulness, among African Americans. Implications for future research are discussed.

Protocol of the HARMONY study: A culturally relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women

BACKGROUND

African American Women (AAW) are at high risk for stress-related cardiometabolic (CM) conditions including obesity, heart disease, and diabetes. Prior interventions lack attention to culturally-nuanced stress phenomena (Superwoman Schema [SWS], contextualized stress, and network stress), which are positively and significantly associated with unhealthy eating and sedentary behavior.

PURPOSE

The HARMONY Study is designed to test a culturally tailored mindfulness-based stress management intervention to address SWS, contextualized stress, and network stress as potential barriers to adherence to healthy exercise and eating goals. The study will help AAW build on their strengths to promote cardiometabolic health by enhancing positive reappraisal, self-regulation, and self-efficacy as protective factors against chronic stress-inducing biobehavioral morbidity and mortality risk.

METHODS

This two-arm, randomized-controlled trial will test the effects of two group-based, online interventions. HARMONY 1 includes culturally-tailored exercise and nutrition education. HARMONY 2 includes mindfulness-based stress reduction, exercise, and nutrition education. We aim to recruit 200 AAW ≥ 18 years old with CM risk.

RESULTS

Primary outcomes (actigraphy and carotenoid levels) and secondary outcomes (body composition, inflammatory markers, glucose metabolism, and stress) are being collected at baseline and 4-, 8-, and 12-months post-intervention. Intent-to-treat, data analytic approaches will be used to test group differences for the primary outcomes.

DISCUSSION

This study is the first to address culturally-nuanced stress phenomena in AAW (SWS, network stress, and contextualized stress) using culturally-tailored stress management, exercise, and nutrition educational approaches to reduce biobehavioral CM risk among AAW. Quantitative and qualitative results will inform the development of scalable and sustainable CM risk-reduction programming for AAW.

TRIAL REGISTRATION

The Multiple PIs registered the clinical trial (Identifier: NCT04705779) and reporting of summary results in ClinicalTrials.gov in accordance with the NIH Policy on the Dissemination of NIH-Funded Clinical Trial Information, within the required timelines.

Trauma-Informed Cultural Humility Mental Health Practice: Centering History among African American Women

Social work has made significant strides in providing mental health services. However, advancement in mental health practices grounded in social work values, such as trauma-informed care and cultural humility mental health practice (CHMHP), is still lacking. One possible reason is that many strategies overlook clients' historical contexts, particularly the collective history held by the community to which the client belongs. By centering "history" in social work practices, clinical social workers can be more equipped to provide high-quality, client-centered services. This article advocates for adopting trauma-informed CHMHP as a critical strategy to elevate history in clinical social work practice and proposes that trauma-informed CHMHP can improve mental health service quality among clients of color who are profoundly disrupted by historical trauma. Specifically, this article proposes that using trauma-informed CHMHP to address historical trauma can enhance mental health treatment outcomes and experiences for African American women. Clinical social workers trained to address these interconnected issues can help reduce disparities in quality treatment access.

Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants

A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.

Primary care-based mindfulness intervention for posttraumatic stress disorder and depression symptoms among Black adults: A pilot feasibility and acceptability randomized controlled trial

OBJECTIVE

There is support for the use of mindfulness-based approaches with trauma-exposed adults. However, limited data are available on feasibility and acceptability of group-based mindfulness interventions in urban medical clinics serving primarily Black adults with low socioeconomic resources, where rates of trauma exposure are high. The present randomized pilot study evaluated the feasibility and acceptability of an 8-week adapted mindfulness-based cognitive therapy (MBCT) group for trauma-exposed Black adults who screened positive for posttraumatic stress disorder (PTSD) and depression in an urban primary care clinic setting.

METHOD

Participants were randomized to waitlist control (WLC) or MBCT. Feasibility and acceptability were assessed through examination of retention rates, measures of group satisfaction and treatment barriers, and qualitative interview. Forty-two Black adults (85% women) were consented; of those, 34 (81%) completed preassessment and randomization.

RESULTS

Feasibility of study design was shown, with > 75% (n = 26) of randomized participants completing the study through postassessment. Twenty-four individuals (70.5%) completed through 1-month follow-up. Results showed high levels of group acceptability across quantitative and qualitative measures. Perceived barriers to psychological treatment were high, with an average of > 6 barriers present.

CONCLUSIONS

The findings indicate feasibility and acceptability of MBCT group interventions in urban primary care settings with trauma-exposed patients with significant psychopathology. However, substantial barriers to treatment engagement were endorsed and to improve numbers for successful engagement in the intervention, continued efforts to reduce treatment barriers and increase access to mindfulness-based interventions in underresourced communities are needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparative effectiveness of a mindfulness-based intervention (M-Body) on depressive symptoms: study protocol of a randomized controlled trial in a Federally Qualified Health Center (FQHC)

BACKGROUND

Mindfulness-based interventions have been shown to improve psychological outcomes including stress, anxiety, and depression in general population studies. However, effectiveness has not been sufficiently examined in racially and ethnically diverse community-based settings. We will evaluate the effectiveness and implementation of a mindfulness-based intervention on depressive symptoms among predominantly Black women at a Federally Qualified Health Center in a metropolitan city.

METHODS

In this 2-armed, stratified, individually randomized group-treated controlled trial, 274 English-speaking participants with depressive symptoms ages 18-65 years old will be randomly assigned to (1) eight weekly, 90-min group sessions of a mindfulness-based intervention (M-Body), or (2) enhanced usual care. Exclusion criteria include suicidal ideation in 30 days prior to enrollment and regular (>4x/week) meditation practice. Study metrics will be assessed at baseline and 2, 4, and 6 months after baseline, through clinical interviews, self-report surveys, and stress biomarker data including blood pressure, heart rate, and stress related biomarkers. The primary study outcome is depressive symptom score after 6 months.

DISCUSSION

If M-Body is found to be an effective intervention for adults with depressive symptoms, this accessible, scalable treatment will widely increase access to mental health treatment in underserved, racial/ethnic minority communities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03620721. Registered on 8 August 2018.

Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Offspring: A Scientific Statement From the American Heart Association

This scientific statement summarizes the available preclinical, epidemiological, and clinical trial evidence that supports the contributions of prepregnancy (and interpregnancy) cardiovascular health to risk of adverse pregnancy outcomes and cardiovascular disease in birthing individuals and offspring. Unfavorable cardiovascular health, as originally defined by the American Heart Association in 2010 and revised in 2022, is prevalent in reproductive-aged individuals. Significant disparities exist in ideal cardiovascular health by race and ethnicity, socioeconomic status, and geography. Because the biological processes leading to adverse pregnancy outcomes begin before conception, interventions focused only during pregnancy may have limited impact on both the pregnant individual and offspring. Therefore, focused attention on the prepregnancy period as a critical life period for optimization of cardiovascular health is needed. This scientific statement applies a life course and intergenerational framework to measure, modify, and monitor prepregnancy cardiovascular health. All clinicians who interact with pregnancy-capable individuals can emphasize optimization of cardiovascular health beginning early in childhood. Clinical trials are needed to investigate prepregnancy interventions to comprehensively target cardiovascular health. Beyond individual-level interventions, community-level interventions must include and engage key stakeholders (eg, community leaders, birthing individuals, families) and target a broad range of antecedent psychosocial and social determinants. In addition, policy-level changes are needed to dismantle structural racism and to improve equitable and high-quality health care delivery because many reproductive-aged individuals have inadequate, fragmented health care before and after pregnancy and between pregnancies (interpregnancy). Leveraging these opportunities to target cardiovascular health has the potential to improve health across the life course and for subsequent generations.

Stress, coping and the acceptability of mindfulness skills among pregnant and parenting women living with HIV in the United States: A focus group study

Pregnant and parenting women living with HIV (WLWH) face high levels of psychological stress and mental illness but lack tailored and acceptable psychosocial treatments. The research team sought to inform the adaptation of a mindfulness intervention for pregnant and parenting WLWH through focus groups exploring psychosocial treatment needs and mindfulness intervention preferences. The research team conducted focus groups with pregnant and parenting WLWH (n = 16) and case managers (n = 6) recruited from a community-based enhanced case management program. The research team utilised an iterative inductive approach to coding of the transcripts from these focus groups. Five themes emerged: stressors, signs of stress, coping, lack of access and acceptability of care, and motivation and trust in care engagement. These focus groups revealed a desire for a group intervention that could decrease isolation while protecting against involuntary disclosure of HIV status. Participants expressed openness to mindfulness skills for coping with stress. The focus group participants' preference for a non-stigmatising group intervention supports the potential of a mindfulness-based group intervention to reduce stress and improve the mental health of pregnant and parenting women living with HIV.

Participation in a yoga intervention is associated with improved mental health among Latinx adolescents

Latinx youth with mental health disorders have worse outcomes when compared to their White (non-Hispanic) counterparts. Latinx youth also have less access to and lower utilization of mental health services. Emerging research supports the psychological and physical benefits of engaging in yoga and yoga may function as a complimentary treatment option for patients with mental health challenges. However, research assessing the efficacy of yoga and mindfulness is particularly sparse among Latinx youth, who may particularly benefit from mind body awareness activities given barriers to more traditional health approaches. The objective of this quasi-experimental study was to examine the effects of a 12-week Vinyasa flow-based yoga group intervention on anxiety, depression, empathy, and life satisfaction among adolescents receiving outpatient mental health treatment. Adolescents (n = 186; 12-17 years old) were recruited to an active intervention condition (Yoga); a subsequent group of participants (n = 91) were recruited in the same manner to an assessment-only comparison control condition (Comparison). The Yoga group participated in culturally and developmentally tailored group yoga classes for 12 weeks. Structural equation modelling was used to evaluate the main effect intervention response between participants in the two conditions. At the post-intervention assessment, after controlling for baseline levels of outcome variables (i.e., depression, anxiety, empathy, and life satisfaction), on average participants in the yoga condition reported: less depression symptoms (B = -1.54, p = 0.008), less anxiety symptoms (B = -0.75, p = 0.048), greater empathy (B = 1.32, p = 0.025) and greater life satisfaction (B = 0.30, p = 0.013) as compared to the Comparison condition. Yoga interventions can be an acceptable and feasible modality for promoting well-being and reducing mental health problems among Latinx youth.

Equitable Mindfulness: The practice of mindfulness for all

The benefits of mindfulness are well-documented; however, these benefits may not be evenly distributed across communities. Equitable Mindfulness aims to make these benefits accessible to a wider and more inclusive audience. The aim of this study was to investigate the applicability of Equitable Mindfulness and systemic barriers that prevent mindfulness programs from being equitably accessed across communities. Twenty-one participants were recruited for qualitative in-depth interviews during a 2-day mindfulness conference. The constant comparison method was used to iteratively identify and categorize themes that emerged within and across interviews. Five dominant themes emerged from the data as follows: inherent equitability, accessibility, inclusiveness, awareness and knowledge-sharing, and acknowledgement of multiple perspectives. Having an applicable and meaningful term to use when describing mindfulness as an inclusive and equitable practice can facilitate the exploration of a new area of research. There is a need for future initiatives aimed at making mindfulness trainings and programs more equitable and accessible to all, regardless of socioeconomic status, race/ethnicity, or abilities/disabilities.

The association of mindfulness and depression stigma among African American women participants in a mindfulness-based intervention: A pilot study

Depression stigma is a potential barrier to engagement in and efficacy of depression treatment. This pilot study examined the association of mindfulness with depression stigma among participants in an eight-week mindfulness-based intervention for depressive symptoms. Thirty-one African American women with depressive symptoms were recruited from an urban Federally Qualified Health Center (FQHC) to participate in a mindfulness intervention (M-Body). Mindfulness, depressive symptoms, and depression stigma were assessed at baseline, eight weeks, and 16 weeks. Focus groups were conducted to examine participants' subjective experiences with the mindfulness intervention. Mindfulness significantly increased from baseline to eight weeks. There was a non-significant decrease in depression from baseline to eight weeks and a significant decrease in depression from baseline to 16 weeks. Depression stigma significantly increased from baseline to eight weeks and significantly decreased from eight to 16 weeks; however, depression stigma did not return to the baseline. An exploratory qualitative analysis of focus group data revealed themes related to direct and indirect factors that may perpetuate and maintain depression stigma. This is one of the first studies to explicitly explore the relationship between mindfulness, depression symptoms, and depression stigma among African American women.

Mindfulness interventions for offsetting health risk following early life stress: Promising directions

Early life stress (ELS), common to childhood maltreatment, socioeconomic disadvantage, and racial discrimination, is thought to create a proinflammatory phenotype that increases risk for poor health in adulthood. Systemic change is needed to address the root causes of ELS, but a substantial number of adults are already at increased health risk by virtue of ELS exposure. Interventions that target stress pathways have the potential to interrupt the trajectory from ELS to inflammatory disease risk in adulthood. Mindfulness-based interventions (MBIs), which train acceptance toward present-moment experience, have shown promise for reducing stress and improving a variety of stress-sensitive health outcomes. Although MBIs have primarily been conducted in more advantaged populations, evidence suggests that they may be uniquely effective for improving mental health and health-related quality of life among those with a history of ELS. Whether these effects extend to physical health remains unknown. To shed light on this question, I review evidence that MBIs influence inflammatory markers in at-risk samples, explore the promise of MBIs for improving stress-related health outcomes in diverse at-risk populations, and describe adaptations to MBIs that may increase their acceptability and efficacy in populations exposed to ELS. This prior work sets the stage for well-controlled RCTs to evaluate whether MBIs influence stress and inflammatory pathways among those exposed to ELS and for pragmatic and implementation trials focused on disseminating MBIs to reach these at-risk populations. Overall, the evidence assembled here shows the potential of MBIs for offsetting physical health risk related to ELS.

Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial

BACKGROUND

Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program "iQuit Mindfully" was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers.

OBJECTIVE

This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic.

METHODS

Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of <US $24,000. They were randomly assigned to either 8 weeks of iQuit Mindfully as a fully automated standalone intervention or iQuit Mindfully in combination with therapist-led in-person group treatment. For participant safety, in-person mindfulness groups were transitioned to the internet and assessments also took place over the internet. Survey questions asked participants about changes in their stress, smoking habits and quit attempts, and their perceptions of the mindfulness and text messaging intervention in the context of the pandemic.

RESULTS

Most participants (n=15 of 21, 71.4%) indicated a change in stress due to the pandemic, of whom 14 (93.3%) indicated higher stress. Participants shared concerns about finances, homelessness, health, and social isolation. Most (n=17 of 21, 80.9%) believed that smoking increases the risk of contracting COVID-19, and although that was motivating for some, others expressed lower motivation to quit smoking because of higher stress. Most (n=18 of 21, 85.7%) stated that practicing mindfulness was helpful during the pandemic. Mean ratings of the helpfulness of text messages and the extent to which they would recommend the program to others were 7.1 (median 8 on a 10-point scale, SD 2.9) and 8.2 (median 9, SD 2.5), respectively. Through open-ended program evaluations, participants shared details about how mindfulness practices and the text messages helped them manage stress and feel a sense of social support during the pandemic. Moreover, 10 of 19 (52.6%) of participants achieved 7-day abstinence from smoking, with no differences between conditions.

CONCLUSIONS

This study supports the promise of text messaging and the use of teleconferencing to provide mindfulness and smoking cessation services to underserved populations during a pandemic.

Promoting Mindfulness in African American Communities

African Americans report higher rates of chronic stress compared to non-Hispanic Whites. Consequently, chronic stress contributes to disproportionately higher rates of poor health outcomes among African Americans. Mindfulness meditation is a well-established and studied strategy to reduce stress and potentially improve health outcomes. However, the practice of mindfulness meditation is largely underutilized in African American communities despite its potential health benefits. In this commentary, we will discuss the relevance of mindfulness interventions, limited research available, reasons for low representation, and cultural adaptations for mindfulness meditation in African American communities. We also provide additional strategies to guide future mindfulness research that target African Americans.

Contributors to Depressed Mood in Black Single Mothers

Participants: A convenience sample of 210 community dwelling Black single mothers ages 18 to 45, who reside in U.S. urban communities.Methods: A descriptive, cross-sectional design was employed. Participants responded to an open-ended question that asked about reasons for depressed mood. A directed approach to content analysis was used to categorize the responses based on existing theoretical formulations and empirical findings about the causes of depression in women. Percentages and frequencies were used to describe the results of the analysis.Findings: A total of 319 usable responses were provided. Collectively and individually the most frequent responses were consistent with Social/Environmental factors such as lack of financial resources (n = 115; 36.05%), followed by Psychological factors such as general cognitive/emotional feelings of stress (n = 60; 18.81%), and parenting stressors or daily hassles (n = 40; 12.54%). Physiologic factors such as a having physiologic or medical conditions were reported less often (n = 14; 4.39%).Conclusions/Implications: Social/Environmental and Psychological factors contribute to depressed mood more often than Physiological factors in Black single mothers. Depression prevention efforts should target the social determinants of mental health in Black single mothers who should be connected with appropriate financial, psychological, educational and social service resources in the community.

Nonpharmacological Self-Management of Migraine Across Social Locations: An Equity-Oriented, Qualitative Analysis

Background

Migraine is a disabling neurological disorder and the sixth biggest cause of disability worldwide. The World Health Organization has declared migraine a major public health problem due to a paucity of knowledge about cause and effective treatment options. Both in incidence and severity, migraine disproportionately affects people occupying marginalized social locations (SL). Managed pharmacologically, migraine is treated with daily preventive and as-needed abortive medications. Both come with high literal and figurative costs: intolerable side effects, medication interactions, and prohibitive prices. Cost prohibitive, ineffective, and unsustainable pharmacological treatment options have contributed to high levels of interest in complementary approaches by people with migraine, but little is known about their motivations, patterns of use or access, or how these may vary by SL.

Method

We conducted focus groups with 30 people with migraine to explore their desires and recommendations for migraine clinicians and researchers. We used qualitative content analysis to identify themes.

Outcomes: We identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication as a short-term solution; high personal and economic costs of medication; and desire for more information and access to natural approaches. Across SL, participants expressed keen interest in integrative approaches and wanted better access to complementary modalities. Participants in marginalized SL described reliance on traditional/folk remedies, including engagement with family and community healers, who they described as more affordable and culturally accessible.

Conclusions

Holistic and integrative approaches were preferred over medication as long-term migraine management strategies. However, people in marginalized SL, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches through currently available channels. Engaging with these communities and using a critical lens to explore barriers to access can develop options to make complementary modalities more approachable, while also attending to systemic blind spots that may unintentionally alienate socially marginalized groups.

Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: A qualitative study

INTRODUCTION

In this study we examined the acceptability and feasibility of a mindfulness based group intervention for socio-economically disadvantaged women in an urban community health center (M-Body).

METHOD

Women ages 18-65 with depressive symptoms who participated in an 8-week mindfulness based group intervention were invited to attend follow up focus groups about their experience. Inductive content analysis was used to identify themes from transcripts.

RESULTS

All participants were African-American (N = 27). Participants had limited past experience with mindfulness. They reported benefits included anger management, increased control of thoughts, emotions and behaviors, enhanced awareness/focus and feeling calm and relaxed. Barriers to session attendance included transportation, employment, family responsibilities and child care. Participants suggested modifications such as providing the audio in multiple formats, increasing time spent doing yoga, modifying yoga postures and providing an orientation session. They stated that the content and delivery format of the group was acceptable.

DISCUSSION

The mindfulness based intervention for depression was acceptable, reduced stress and improved coping and functioning among women in a community health center.

A Mindfulness-Based Intervention for Low-Income African American Women with Depressive Symptoms Delivered by an Experienced Instructor Versus a Novice Instructor

Introduction: In the present study, the authors pilot a streamlined mindfulness teacher training protocol for Federally Qualified Health Center (FQHC) staff and examine the distribution and variability of psychologic outcomes for participants in groups led by an experienced instructor compared to a FQHC staff instructor who received the streamlined training. Methods: Seventy-four adult women aged 18-65 with depressive symptoms enrolled to participate in the 8-week group mindfulness intervention led by an experienced instructor (N = 33) or a novice instructor (N = 41). The effect of instructor on the outcomes depression, stress, mindfulness, functioning, well-being, and depression stigma was assessed at baseline, 8, and 16 weeks. Results: Depressive symptoms and stress significantly decreased, and mindfulness significantly increased in the experienced and novice instructor groups. In the novice instructor group, there was also a significant increase in well-being and functioning. The change in depressive symptoms, stress, functioning, and well-being was significantly greater in the novice instructor group than the experienced instructor groups. Conclusions: Preliminary data suggest that health care staff who receive streamlined training to deliver mindfulness-based interventions have comparable outcomes as experienced instructors.

Past Discrimination, Race-Related Vigilance, and Depressive Symptoms: The Moderating Role of Mindfulness

Objectives

African Americans experience numerous adverse health consequences due to race-related stress. Yet, mindfulness may serve as a relevant and vital protective factor in the link between race-related stressors and depressive symptoms for this population.

Methods

Data from 190 African American participants, ages 18-53, were used to investigate if past discrimination and race-related vigilance, two types of race-related stressors, interactively predicted greater depressive symptomatology among this sample. We also assessed if mindfulness moderated the association between race-related stressors, as indicated by past discrimination and race-related vigilance, and depressive symptomatology.

Results

Our results indicated that past discrimination and race-related vigilance did not interactively predict depressive symptomatology in our sample; however, these stressors were independently related to greater depressive symptoms. Additionally, we found that greater levels of mindfulness were associated with lower levels of depressive symptoms, and mindfulness significantly moderated the association between both race-related stressors and depressive symptoms.

Conclusions

These findings support mindfulness' ability to buffer the negative health consequences of past discrimination and race-related vigilance for African Americans. Additional conclusions and future research directions are discussed.

Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: A Pilot Randomized Controlled Trial

Objectives

Mindfulness is effective for reducing anxiety and depression and increasing chronic disease self-management. An accessible, insurance-reimbursable model for implementation in patient-centered medical homes within US healthcare systems has promise for patients with multi-morbid conditions. Clarifying both the dose needed to impact anxiety, depression and self-management, and the design requirements for accessible primary care implementation, is essential.

Methods

We tested feasibility, acceptability, and effectiveness of Mindfulness Training for Primary Care (MTPC), an 8-week, referral-based, insurance-reimbursable mindfulness program integrated within primary care, compared with a Low-Dose Comparator (LDC), consisting of a 60-minute mindfulness introduction plus referral to community and digital resources. Outcome measures were assessed at baseline and 8 weeks. MTPC is trauma-informed, incorporates mindfulness-oriented behavior change skills, and is designed to target anxiety, depression, stress, and chronic illness selfmanagement. Participants schedule a PCP visit to co-create a self-management action plan during week 6.

Results

Primary care providers (PCP) referred 344 patients over 14 months. Eighty-one participants with DSM-V anxiety disorders, depressive disorders, trauma- and stress-related disorders participated in this pilot randomized-controlled comparative effectiveness trial [MTPC (n=54); LDC (n=27)]. These data suggest that MTPC was more effective than LDC for reducing anxiety (p=0.01), enhancing mindfulness (p=0.02) and self-compassion (p=0.001), and for catalyzing selfmanagement behavior change through action plan initiation (OR=4.34, p=0.03).

Conclusions

MTPC was successfully integrated into a health system, was billed to insurance, and was acceptable to a diverse primary care population. Replication with a larger study and further accessibility adaptations are needed to confirm and expand these pilot results.

Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial

BACKGROUND

Self-management of health is important for improving health outcomes among primary care patients with chronic disease. Anxiety and depressive disorders are common and interfere with self-regulation, which is required for disease self-management. An insurance-reimbursable mindfulness intervention integrated within primary care may be effective for enhancing chronic disease self-management behaviors among primary care patients with anxiety, depression, trauma, and stress-related and adjustment disorders compared with the increasingly standard practice of referring patients to outside mindfulness resources.

OBJECTIVE

Mindfulness Training for Primary Care (MTPC) is an 8-week, referral-based, insurance-reimbursable program integrated into safety-net health system patient-centered medical homes. We hypothesized that MTPC would be more effective for catalyzing chronic disease self-management action plan initiation within 2 weeks, versus a low-dose comparator (LDC) consisting of a 60-min mindfulness introduction, referral to community and digital resources, and addition to a 6-month waitlist for MTPC.

PARTICIPANTS

Primary care providers (PCPs) and mental health clinicians referred 465 patients over 12 months. All participants had a DSM-V diagnosis.

DESIGN AND INTERVENTIONS

Participants (N = 136) were randomized in a 2:1 allocation to MTPC (n = 92) or LDC (n = 44) in a randomized controlled comparative effectiveness trial. MTPC incorporates mindfulness, self-compassion, and mindfulness-oriented behavior change skills and is delivered as insurance-reimbursable visits within primary care. Participants took part in a chronic disease self-management action planning protocol at week 7.

MAIN MEASURES

Level of self-reported action plan initiation on the action plan initiation survey by week 9.

KEY RESULTS

Participants randomized to MTPC, relative to LDC, had significantly higher adjusted odds of self-management action plan initiation in an intention-to-treat analysis (OR = 2.28; 95% CI = 1.02 to 5.06, p = 0.025).

CONCLUSIONS

An 8-week dose of mindfulness training is more effective than a low-dose mindfulness comparator in facilitating chronic disease self-management behavior change among primary care patients.

Mindfulness-based interventions for addictions among diverse and underserved populations

Mindfulness-based interventions (MBIs) show strong promise for treating addictions, but there is much work to be done to ensure that they are culturally appropriate, accessible, and optimally effective for priority populations who could potentially have the most to gain. This article briefly highlights research on MBIs for addictions among diverse and underserved populations and proposes next steps for increasing their potential to target addiction-related health disparities. Future directions include: 1) Prioritize diversity in clinical trials and conduct appropriately powered moderation analyses; 2) Consider treatment adaptations; 3) Examine underlying mechanisms to optimize MBIs for specific populations; 4) Improve implementation in community-based and other appropriate settings; and 5) Consider use of technology to provide just-in-time support and increase scalability for diverse populations.

Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research

BACKGROUND

Mindfulness-based programs show promise for promoting smoking cessation in diverse populations. Mobile health strategies could increase treatment engagement and in-the-moment support, thus enhancing the effects of mindfulness-based smoking cessation interventions. However, most mobile health programs have been developed without sufficient input from the target population.

OBJECTIVE

By eliciting input from the target population, predominantly low socioeconomic status (SES) African American adult smokers, throughout the development of an SMS (short message service) text messaging program that teaches mindfulness for smoking cessation, we aimed for the resulting program to be optimally effective and consistent with participants' needs and preferences.

METHODS

Two qualitative studies (N=25) were conducted with predominantly low SES, African American adult smokers. In Study 1 (initial qualitative input; n=15), participants engaged in focus groups to provide suggestions for program development. In Study 2 (abbreviated trial; n=10), participants received a 1-week version of the SMS text messaging program and provided feedback through in-depth interviews.

RESULTS

In Study 1, participants suggested that the SMS text messaging program should be personalized and interactive (ie, involve two-way messaging); provide strategies for coping with cravings and recovering from smoking lapses; involve relatively short, to-the-point messages; and include pictures. In Study 2, participants were highly engaged with the texts, indicated that the program was useful, and provided additional suggestions for improvement.

CONCLUSIONS

Eliciting feedback from the target population throughout the intervention development process allowed for iterative revisions to increase feasibility, acceptability, and effectiveness. Overall, SMS text messaging appears to be a feasible, appealing way to provide in-the-moment personalized support and encourage mindfulness among low-income African American smokers.

Recommendations for a culturally-responsive mindfulness-based intervention for African Americans

BACKGROUND

African Americans are at increased risk for stress-related disparities. Mindfulness-based interventions are effective in reducing adverse outcomes; yet, racial/ethnic minorities are underrepresented in these interventions. Also, the development of culturally-responsive interventions has been mostly non-existent.

MATERIALS AND METHODS

Focus group and interview data were acquired following a four-week mindfulness intervention with African American women.

RESULTS

Using Brigg's (2011) mental health utilization model to guide analysis, several recommended culturally-responsive modifications emerged. Recommended modifications internal to the intervention included using African American facilitators, incorporating cultural values, using culturally-familiar terminology, and providing cultural resources. Suggested modifications to the intervention's external factors included offering the intervention within culturally-familiar settings. Individual-level factors to address were religious concerns, perceived benefits, and holistic health goals.

CONCLUSIONS

Themes were used to propose a model toward the creation of a culturally-responsive mindfulness-based interventions to guide culturally-relevant treatment modifications and improve underserved communities' engagement in these interventions.

Mind-Body Therapies for African-American Women at Risk for Cardiometabolic Disease: A Systematic Review

Background

A major determinant in cardiometabolic health is metabolic syndrome (MetS), a cluster of symptoms that portend the development of cardiovascular disease (CVD). As mind-body therapies are thought to help in lowering physiological and environmental CVD risk factors including blood pressure and psychological stress, they may also be beneficial for the primary prevention of CVD.

Objectives

To synthesize and summarize existing knowledge on the effectiveness of mind-body therapies on MetS outcomes in African-American (AA) women, a US subpopulation at high risk for CVD.

Search Methods

A systematic search of eight databases was conducted in order to identify published papers addressing the topic. We included trials involving AA adult women, ages 18–64, and we included RCTs that involved multifactorial interventions. Outcomes of interest were MetS, chronic disease, and CVD risk factors (blood pressure, blood lipids, blood glucose, BMI, waist circumference, and mental health domains). Two authors independently selected trials for inclusion, extracted data, and assessed risks of bias.

Main Results

We identified five trials for inclusion in this review. One study reported outcomes associated with the full MetS symptom cluster. The included trials were small, short term, and at high risk of bias. All interventions lasted at least 6 weeks.